Sometimes we all need help from time to time. If we’ve gained a dependence on drugs and/or alcohol, we need to seek out some possible ways to help us clean up our act.
One possible way to do this is by checking into a rehab facility. These treatment facilities are a perfect way for some people to get a helping hand during one of the toughest times of their lives, and provide you with the support that you might not otherwise have had.
Typically, most insurances will cover substance abuse treatment to some degree, but not every insurance provider will and depending on your insurance plans, the extent to how much treatment you receive can vary.
The main factors will be the insurance policy’s behavioral health benefits, which rehab provider you go with and what specific needs you require.
However, there’s much more to it than that. This guide will examine if your insurance company will provide coverage for addiction treatment, how it works and what you should do if your insurance won’t cover the treatment you need.
The Basic Terminology
Before we dive into the specifics, it’s important that we define some keywords and phrases that are used in the context of health insurance and rehabilitation treatments. It’s common for an insurance company to try to overuse jargon which customers don’t ask the meaning of.
Deductible
Deductible is sometimes known as excess. It refers to the amount of money a person must spend first before their insurance coverage begins.
So, for example – if the insurance requests a $3,000 deductible, you must initially pay $3,000 before you get insurance to pay for the rest of the treatment. Think of it similarly to a down-payment for a mortgage.
Co-payment
Sometimes, after the deductible payment has been met – a person might be requested to make co-payments. For example, this could be $25 for a visit to the doctor’s.
Co-insurance
This is a percentage of costs made payable after the deductible has been met.
Premium
This is the cost for your insurance policy that you pay on a monthly or yearly basis.
In-Network Provider
Your insurance firm has an agreed healthcare provider that they use within this network and it will provide discounted rates for their services.
Out-Of-Network Provider
The opposite of the former, your insurance firm does not have any agreements with a healthcare provider.
Out-Of-Pocket/Limit
Out-of-pocket expenses are the once that you personally are responsible for paying out for. The limit refers to the maximum cost you will personally pay out for the duration of that year.
Does My Insurance Cover Substance Addiction Treatments?
Typically, yes. Most insurance coverage will extend to covering substance abuse treatments including drugs and alcohol. The insurance may also cover things like mental health treatments and services.
However, the extent of how much they cover will depend largely on what insurance policy you have including your health plans and anything within the policy that states you are responsible for when it comes to out-of-pocket expenses.
Before you decide to enter a rehabilitation center, you should always clarify with your insurance provider what exactly you’re covered for and to what extent they will cover the costs. It’s also advised that you contact the particular rehab center and ask them.
A lot of rehab centers will know, at least to some extent, what providers offer what – although they might not know the full policy coverage. They can, however, provide you with advice and possible details of other important factors in the process.
Why Do Health Insurance Plans Cover Addiction Treatments?
The entire point behind a health insurance plan with health insurance providers is that they want to make healthcare and health services much more accessible and affordable to the public.
Unlike in some countries, the US does not have a publicly funded health system, so getting a good health plan is critical.
As with a good deal of other health related issues, addiction can cause serious problems and ruin lives. Unfortunately, those addicted to alcohol or drugs often have financial worries, relationship struggles and their general health suffers.
During this time, the person’s mental health can be detrimentally affected too. With some treatment centers, a large focus on the treatment includes mental health services – along with drug and alcohol addiction treatment.
The goal with these addiction treatment services, and the health insurance plan that covers it, is to get the person impacted through the process and hopefully, get the person clean and sober – with all the support and guidance they need to not abuse substances again.
This should lead to a healthier life and a new lease of life, allowing for the person to get back into employment and fix potentially broken relationships.
What Sort Of Treatment Do Rehabilitation Centers Offer?
There are many types of treatment that these centers offer, but what you can get covered by your insurance will differ from policy to policy and provider to provider.
Typically though, you can expect most providers to cover the majority of treatments on offer. They can include things like:
- Inpatient/residential rehabilitation service treatments
- Outpatient services and care
- Ongoing and continuous care such as therapy or counseling
- Detox programs
- Medication assisted treatment
- Mental health treatments (alongside other treatments)
- Support for post-services and ongoing sobriety services
What If I Don’t Have Insurance?
Unfortunately, the cost of addiction treatment isn’t cheap – but there are ways you can cover the treatment costs.
Treatment for substance abuse is critical, and you should always seek out a type of treatment that suits you, even if you do not have health insurance – or if you have a policy that does not cover addiction services, although that is not common.
There are some state-funded options and even some free rehab centers available to access. States may offer you financial help to get the services that you require if they do not have any health insurance or are on very low income.
The services that the state will fund will likely be low cost substance services and programs. To find what these are, you’ll need to access your search engine and look for low-cost rehab services or state funded rehab services.
If however, you do not qualify for this funding or these services, or you do not have access to these services in your city or state, then there are some other options to cover the cost of addiction treatment facilities.
These include:
Loans
There are many lenders that will allow you to apply for a loan to cover the costs of rehab services, assuming you qualify financially and circumstantially. If this is the option you’re looking at, always consider if you can afford to pay it back and your general financial situation.
Payment Plans
Many treatment centers will provide coverage of the treatments that you require on the basis of an agreed payment plan. The center will outline exactly the costs of the treatment and how much you would be required to pay for them on a monthly or annual basis.
Scholarship Program
Depending on the criteria, some treatment centers or third parties will offer a scholarship or grant system to those who require financial aid towards coverage for treatment.
It’s also possible for a state to provide financial assistance for these services and treatments. It’s always a good idea to ask around your state or utilize your search engine to see if your state provides this sort of help.
Ask Your Family Or Friends For Help
Even though it’s not always easy, if you really need the help – those that love you the most will almost certainly provide. If you need help with addiction treatment coverage, mental health treatment or any other medical treatment for that matter, never remain silent.
Always ask for help when you need it and never consider it a stigma. There are those out there that want to help and will always be on hand for you, financially and emotionally.
What About ObamaCare?
The Affordable Care Act 2010 made it into law that medical care was more accessible and more affordable for all Americans and to expand the delivery methods of how medicare was offered and rolled out.
It also states that no person will be denied medical care, regardless of who they are or what their personal circumstances are – including their financial capabilities.
By doing so, it meant that substance abuse treatment made it into the classification of essential health care along with mental health treatments too.
Is It Possible To Have More Than One Insurance Provider?
It is entirely possible to have more than one health insurance policy and provider, but there are specific criteria that you have to meet before this happens. If this happens, multiple insurers cover one person and cover towards the cost of certain health care.
This is known as coordination of benefits. Generally, you can have multiple insurance if you:
- You are 65 or over and have cover through your employer’s medicare.
- You are a dependent via both parents due to divorce whilst being 26 years old or younger and are listed on both of their health plans.
- You are 26 or younger and have your own plan with one or more parents.
- You are married and are covered via your spouse’s insurance plan.
The way these plans work is that one of them will be classified as your primary healthcare plan and the other will be known as your secondary healthcare plan.
After your primary insurance provider has reached their limits of coverage, you can call upon your second provider to cover further, or the rest, of the costs that are being requested. It is still entirely possible for the full costs of the treatment to not be reached, and you may have some out-of-pocket expenses.
What Are The Main Types Of Healthcare Plans And Benefits?
There are three major types of healthcare plans with their own benefits. There is HMO, POS and PPO. Below are what each one offers in their plan:
HMO (Health Maintenance Organization)
These types of plans allow the plan holder to choose their primary physician for their medical care. This allows the person to meet up and gain a rapport with their chosen doctor over a number of visits.
If the person needs to seek out a doctor that is outside the network, the primary doctor needs to give consent and refer them to the secondary physician.
These plans generally have a decreased or non-existent level of deductibles and the costs overall for the plans are usually much less expensive than that of the other plans. This includes a cheaper monthly or annual premium.
The pros for opting for an HMO type plan is that you are able to have your own doctor and gain a much more in depth rapport and history of your health with them. Typically, you will be able to contact them the majority of the time too.
As HMO plans cover the cost of all services in their network, you do not typically have to pay extra for other services – however, if you choose to go outside your network, there will likely be out-of-pocket expenses.
PPO (Preferred Provider Organization)
Unlike HMOs, PPO plans allow patients to seek out assistance inside and outside their network and do not require their doctor for a referral. You also do not have a primary doctor and therefore can pick and pick a doctor of your choice for whatever you so wish.
If you were to stay within the network, you’ll likely pay less, but you have the option to select your own physicians.
These types of plans will generally have much higher premiums with a higher deductible cost. In essence, you’re allowed more freedom with a PPO plan, but you’re going to have to pay more for the privilege.
POS (Point Of Sale)
These plans are very similar to HMO plans, but you can often seek doctors outside your network without a referral which is what some plans refer to as a “point of services” clause.
What your point of sale plan will allow you to do and what they will cover will differ from provider to provider, so you will have to ensure that you’ve checked everything fully in your plan before you go for specific services.
Which One Is Best?
It really comes down to your personal preferences and affordability. You are debating between flexibility and affordability. For example, HMO plans are among the most common in the US and are usually the most affordable, but there are limits to what you can do or request.
Whereas, PPO plans are normally more expensive, but your premium costs also allow you to access physicians for things like non-emergencies and medical advice.
Each has their own specific benefits so always check to see which one is best for you.
What About The Costs Of Drug Addiction Coverage?
As we mentioned, most plans will cover the costs or at least, a portion of the costs for drug dependence treatment or other services.
The actual cost of the treatment like rehab will be dependent on the person, their treatments, their duration of treatment, their insurance coverage and a few other personal things.
Due to these variants, the costs that a person may have (out-of-pocket expenses) can be wildly different from another person.
If plans are within the health insurance marketplace, they must provide care under the ObamaCare Act. This means they must provide financial assistance through their plans for addiction.
However, there is no hard and fast rule with what addiction treatment means as such, in that they cannot differentiate between a person with a drug addiction, alcohol dependence, sex addiction, gambling addiction or even an addiction to food.
The reason for this ambiguity is that if the insurance firms decided to differentiate between care for specific things, the plans would soar in their costs and likely would not be purchased.
Therefore, the insurer will place all of these under one umbrella category for services and alleviate some costs, such as underwriters, specialists and administration that would be moved onto the customer.
When this comes to drug and alcohol addiction, they will not differentiate between heroin, cocaine etc. but rather the umbrella category of drugs.
If they were to go too far into it, they would have to start questioning the drug in terms of its origin, its chemical composition etc. and the price for this would skyrocket.
By employing this thought process, states will also keep their costs down to a minimum too, which means that the average citizen in that specific state should not be paying extra taxes.
These costs are saved in many ways. One way is, by merging all the drugs into a larger umbrella term of addiction, states can choose to request that someone attends residential rehabilitation centers for one year, as opposed to putting someone in jail for a year.
The savings of a decision like this are huge, not just for the state’s cost to keep someone incarcerated but also by providing this level of robust care for all drugs as opposed to one or two drugs that can allow more people to recover.
Additionally, in many ways – people would be much better off in this type of facility rather than in jail where drugs can be prevalent, which can lead to relapse, further crimes or even overdose – all of which can reap more expensive costs.
Not just this, but even the costs of private plans can be reduced when states use this thought process. If someone ends up in hospital due to an overdose or drug related injury, they may need to have very expensive surgery or even organ transplants.
By keeping people safe by providing addiction care means that premiums of health insurance can remain lower.
What About People That Need Mental Health Treatments?
Because of the Affordable Care Act 2010, anyone that needs mental health treatment can access it in a more affordable way. The best way to explain what this means is, if a person needs to access a doctor for a pain in their wrist, it will cost the same as accessing a doctor with depression.
Much like in the previous point, insurers do not explicitly say what mental health conditions are included in the plans. In other words, they do not differentiate between someone with depression or schizophrenia.
This is for the same reason as putting other things in umbrella branches – it saves on costs. It reduces the amount of paperwork and number of employees and medical tests that would be required to make each condition specific.
But this does not mean you need to panic. If you fear you have developed a mental health condition due to the abuse of alcohol or drugs, or even vice versa – health insurers cannot exclude you for a specific mental health condition.
Will The Insurer Cover The Costs For Medication?
If it is within your policy, the insurer will cover the costs (or part of the costs) for what is known as ongoing care. Ongoing care can include medications that some people who are dependent on substances may need to have when they leave residential rehab.
These medications are for certain drugs due to the chemical imbalances and alterations that have been caused by drug use. Without the use of counterbalancing medications, a person may fall very unwell and in some instances it could be fatal.
They are also required for the symptoms of things like withdrawal and try to reduce the strong cravings for the drug which, when not administered, could lead to a relapse.
Methadone is common for people who were abusing heroin. It mirrors some effects of heroin without being as toxic or deadly and reduces the risk of a hard comedown and withdrawal which can be fatal with a drug as powerful as heroin.
Additionally, due to its addictive properties – it’s one of the most difficult to come off of and methadone can be very beneficial.
Antabuse is often used for alcohol addiction. It does not stop cravings or any of the psychological problems that might come with alcohol abuse, but it makes the person less likely to drink alcohol because Antabuse makes a person violently vomit if they drink it.
The aim is to psychologically “train” the person to avoid alcohol and link it with bad experiences. While these types of medication are life-saving, they are not cheap. Luckily though, most insurers will cover these costs.
Rehab V Addiction
Remember, whatever your circumstances are in terms of your insurance – the overall costs of addiction will be much more costly and this might not only be financially, but you may lose your own life or lose your family.
Never be afraid or apprehensive to request help for addiction or substance abuse – if you think you have a concern, always reach out and get yourself better.
You will thank yourself in the long run and so will your loved ones. The financial aspects of rehab might seem like a scary concept, but there are always ways to get the help you need.
The Bottom Line
Insurance typically will cover the cost of drug and alcohol rehab, in very rare circumstances it will not. How much they cover will depend on a variety of factors, so you should always check your policy with your provider.
If you do not have insurance, you still have other options, either via the state or through loans and grants. If you need help, speak with someone who can help you